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Give older women and same sex couples fertility treatment, says NICE

Watchdog updates 2004 recommendations and broadens eligibility criteria

Caroline White

Tuesday, 22 May 2012

Women in their early 40s and same sex couples should have access to some types of fertility treatment on the NHS, says NICE in draft guidance published today.

Infertility affects around one in six straight couples in the UK. But in 2010, just four out of 10 in vitro fertilisation (IVF) cycles were funded by the NHS at a cost of between £1,300 to £3,500.

The new draft guidance, which now goes out to public consultation, updates NICE recommendations on fertility treatment published in 2004.

"Since the original recommendations on fertility were published in 2004 there have been many advances in both treatments and in the understanding of different techniques,” explained Dr Gill Leng, Deputy Chief Executive of NICE.

“For this update we are using the latest statistical and clinical evidence to make sure that treatment for infertility is offered at a time and in a way which is most likely to result in pregnancy,” she added.

"The aim of these new and updated recommendations is to ensure that everyone who has problems with fertility has access to the best levels of help,” she said.

The new guidance recommends that several new groups should be offered fertility treatment, including people who are preparing for cancer treatment who may wish to preserve their fertility, those with an infectious disease, such as hepatitis B or HIV.

Healthcare professionals should advise couples that the risk of the man passing on HIV to his female partner is negligible through unprotected sex if he is taking highly active antiretroviral therapy; has a plasma viral load of less than 50 copies/ml; has no other infections; and unprotected sex is limited to the time of ovulation, says the guidance.

The new guidance also broadens the criteria for treatment. Women aged 23 to 39 who have not conceived after two years of regular unprotected sex or after 12 cycles of artificial insemination should be offered three full treatment cycles of IVF with or without intracytoplasmic sperm injection, the guidance recommends.

And women aged 40 to 42 years who have not had IVF treatment should be able to have one full cycle of IVF, with or without intracytoplasmic sperm injection, where there is no chance of pregnancy and where IVF is the only effective treatment, it says.

The 2004 guidance recommended that no more than two embryos should be transferred during any one cycle of IVF. The latest guidance includes the option for a double transfer if no premium quality embryos are available for the second full IVF cycle in women up to 37.

For women aged 37 to 39, double transfer is an option if there are no premium quality embryos in the first and second full IVF cycles.

But no more than two embryos should be transferred for the third cycle in both these age groups, says the guidance.

For women aged 40-42 years double embryo transfer should be considered for unexplained fertility, says the guidance, but it does not recommend drugs to stimulate the ovaries.

The new guidance does not support the use of intrauterine insemination in couples with mild male factor infertility, unexplained fertility problems, or minimal to mild endometriosis as the evidence shows that couples have an 80% chance of becoming pregnant if they continue to try to conceive for two years without medical intervention.

But unstimulated intrauterine insemination should be considered as an alternative to penetrative sex for those unable to have this type of sex because of a physical or psychological disability and for same sex couples, the guidance recommends.

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